Smoking Cessation: A Report of 

the Surgeon General

2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of the Surgeon General

Rockville, MD
National Library of Medicine Cataloging-in-Publication Data

Names: United States. Public Health Service. Office of the Surgeon General, issuing body. | National 

Center for Chronic Disease Prevention and Health Promotion (U.S.). Office on Smoking and 

Health, issuing body.

Title: Smoking cessation: a report of the Surgeon General.

Other titles: Smoking cessation (Office of the Surgeon General)

Description: Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 

Office of the Surgeon General; Atlanta, GA: U.S. Department of Health and Human Services, Centers 

for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health, 2020. | Includes bibliographical references.

Subjects: MESH: Smoking Cessation. | United States.

Classification: NLM WM 295

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion 

Office on Smoking and Health

For more information

For more information about the Surgeon General’s report, visit www.surgeongeneral.gov.

To download copies of this document, go to www.surgeongeneral.gov.

To order copies of this document, go to www.cdc.gov/tobacco and click on Publications 

Catalog or call 1-800-CDC-INFO (1-800-232-4636); TTY: 1-888-232-6348.

Suggested Citation

U.S. Department of Health and Human Services. Smoking Cessation. A Report of 

the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 

Centers for Disease Control and Prevention, National Center for Chronic Disease 

Prevention and Health Promotion, Office on Smoking and Health, 2020.

Use of trade names is for identification only and does not constitute endorsement by the 

U.S. Department of Health and Human Services.
iii

Message from Alex M. Azar II

Secretary, U.S. Department of Health and Human Services

Throughout its history, the U.S. Department of Health and Human Services (USDHHS) has led 

efforts to prevent and reduce the devastating effects of tobacco use, especially the use of combustible tobacco products, as part of its mission to enhance and protect the health and well-being of all 

Americans. USDHHS has provided critical support in the fields of research and evaluation, program and 

policy development, public information and education, regulatory activities, systems-level change and 

management, and clinical practices that has contributed to a dramatic 67% decline in cigarette smoking 

among U.S. adults since 1965. Support from USDHHS has helped medical and healthcare organizations, government agencies at all levels, and nongovernmental partners create and sustain programs 

that prevent initiation; help tobacco product users quit; and foster healthy, smokefree environments.

This report is the latest of a longstanding tradition of tobacco prevention and control efforts 

by USDHHS. Our work includes a comprehensive tobacco control strategic action plan, Ending the 

Tobacco Epidemic, and coordination of tobacco control efforts with related efforts by other federal agencies through the Interagency Committee on Smoking and Health. Reports such as this one from the 

U.S. Surgeon General give the latest data on tobacco and health to scientists, healthcare professionals, 

and the public. Research leadership and grant funding through USDHHS’s National Institutes of Health 

contribute to growing knowledge of effective tobacco control strategies and smoking cessation tools. 

The National Tobacco Control Program, led by the Centers for Disease Control and Prevention (CDC), 

ensures that these strategies and tools are readily available to state, local, tribal, and territorial public 

health programs, as well as to partners serving a variety of populations that are disproportionately 

affected by tobacco use. The U.S. Food and Drug Administration (FDA) regulates the manufacturing, 

marketing, and sale of tobacco products. Medicare and Medicaid provide smoking cessation tools and 

support to millions of Americans. Multiple public information campaigns, such as CDC’s Tips From

Former Smokers and FDA’s Every Try Counts, educate Americans about the significant health risks 

from smoking and the importance of quitting. Additionally, many agencies in USDHHS provide direct 

assistance to smokers, including the National Cancer Institute through its Smokefree.gov initiative 

(https://smokefree.gov), and national quitline portal, 1-800-QUIT-NOW.

These and other important efforts are critical to improving the nation’s public health. Smoking 

kills nearly half a million Americans every year, and millions more live with serious chronic diseases 

caused by smoking. We know that comprehensive interventions at all levels of government and by 

partners throughout the public health community are extremely effective at preventing and reducing 

tobacco use. We remain committed to ending the tobacco use epidemic in the United States.

v

Foreword

Tobacco use remains the number one cause of preventable disease, disability, and death in the 

United States. Approximately 34 million American adults currently smoke cigarettes, with most of 

them smoking daily. Nearly all adult smokers have been smoking since adolescence. More than twothirds of smokers say they want to quit, and every day thousands try to quit. But because the nicotine 

in cigarettes is highly addictive, it takes most smokers multiple attempts to quit for good.

Today, we know much more about the science of quitting than ever before. Research shows that 

smokers who use evidence-based tools to help them quit are more likely to succeed than those who do not 

use such tools, and that using a combination of these tools—for example, calling 1-800-QUIT-NOW and 

using nicotine replacement therapy, such as the nicotine patch or gum or a prescription medication—

raises success rates even higher. Studies also show that policies that prohibit smoking in indoor public 

places and work spaces and that increase the price of tobacco products promote smoking cessation.

This Surgeon General’s report

• Examines the effectiveness of various smoking cessation tools and resources;

• Reviews the health effects of smoking and catalogues the improvements to health that can occur 

when smokers quit;

• Highlights important new data on populations in which the prevalence of smoking is high and quit 

rates are low; and

• Identifies gaps in the availability and utilization of programs, policies, and resources that can 

improve cessation rates and help smokers quit.

Although the benefits of quitting are greater the earlier in life that an individual quits, this report 

confirms that it is never too late to quit smoking. Even persons who have smoked for many years or who 

have smoked heavily can realize health and financial benefits from quitting smoking.

The financial toll of smoking is substantial. Each year in the United States, annual healthcare 

spending attributed to smoking exceeds $170 billion. Measured against these numbers, comprehensive 

tobacco prevention and control strategies are extremely cost-effective investments that yield significant 

returns. For example, the first year of CDC’s Tips From Former Smokers national campaign prevented 

thousands of premature deaths in the United States, costing less than $500 for every smoker who quit.

We know what works to prevent and reduce tobacco use, including how to best help smokers quit 

for good. Putting this knowledge into action prevents disease, saves lives, and improves the quality of 

life for all Americans. At CDC, we remain committed to supporting the longstanding national effort to 

end the tobacco use epidemic and provide all Americans with the opportunity to live tobacco-free.

Robert R. Redfield, M.D.

Director

Centers for Disease Control and Prevention

vii

Preface

from the Surgeon General

One of the most significant public health successes in modern U.S. history has been the reduction 

in smoking that has occurred during the past half century. Today, the prevalence of cigarette smoking 

among American adults is at an all-time low, 14%. Although this overall achievement is a source of 

pride, there is still more work to be done. Today, 16 million Americans are living with a smoking-related 

disease. In addition to the human costs, smoking places a significant financial burden on Americans, 

as smoking-attributable healthcare spending exceeds $170 billion per year.

Research, medical advances, and years of documented experience have given us many tools to 

tackle the tobacco use epidemic in this country. Although quitting smoking can be a difficult process for many smokers, most say they want to quit, and every year more than half make a serious quit 

attempt. But only a small portion of smokers who try to quit succeed, and only a small portion use any 

of the tested and proven aids that will significantly increase their chances of success. This Surgeon 

General’s report on smoking cessation, the 34th report on smoking and health since 1964, examines 

the most current research on this important issue, identifies barriers to continued success in reducing 

the prevalence of smoking across all populations, and summarizes evidence-based solutions that can 

help to eliminate those barriers.

Clinical interventions for smoking cessation are critical if we are to achieve our goal of eliminating the devastating effects of smoking on public health. Primary care physicians, nurses, pharmacists, and other providers in all medical disciplines and in all healthcare environments should take 

advantage of these opportunities to inform and encourage smokers to quit. Doing so could enable half 

a million smokers to quit each year.

As a physician, I am acutely aware of the many pressing demands that healthcare providers must 

address to deliver the highest quality care possible to their patients. At the same time, the evidence in 

this report clearly points to the tremendous positive impact that healthcare professionals can have on 

the health and quality of life of their patients and on the public health of our nation—just by helping 

smokers to quit.

But healthcare professionals alone cannot solve this public health challenge. Everyone has a role 

in helping to continue to reduce the burden of tobacco use on our society. It is critical that clinical 

interventions be adopted alongside broader efforts at the health system and population levels to promote and cultivate successful cessation and tobacco-free norms. Even today, with all the gains that have 

been made over the past few decades, smoking remains the single largest cause of preventable disease 

and death in the United States. As a nation, we can and must spare no effort to reduce the completely 

preventable health and financial costs that tobacco smoking has on society.

Jerome M. Adams, M.D., M.P.H.

Vice Admiral, U.S. Public Health Service

Surgeon General of the United States

Smoking Cessation

ix

Acknowledgments

This report was prepared by the U.S. Department of Health 

and Human Services under the general direction of the 

Centers for Disease Control and Prevention, National 

Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health.

Vice Admiral (VADM) Jerome M. Adams, M.D., M.P.H., 

Surgeon General, U.S. Public Health Service, Office of 

the Assistant Secretary for Health, Office of the Surgeon 

General, Office of the Secretary, U.S. Department of Health 

and Human Services, Washington, D.C.

Robert R. Redfield, M.D., Director, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Dana Shelton, M.P.H., Director (Acting), National Center for 

Chronic Disease Prevention and Health Promotion, Centers 

for Disease Control and Prevention, Atlanta, Georgia.

Peter A. Briss, M.D., M.P.H., Medical Director, National 

Center for Chronic Disease Prevention and Health 

Promotion, Centers for Disease Control and Prevention, 

Atlanta, Georgia.

Rachel Kaufmann, Ph.D., M.P.H., Associate Director for 

Science, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Corinne Graffunder, Dr.P.H., M.P.H., Director, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Editors of the report were

Rachel A. Grana, Ph.D., M.P.H., Senior Scientific Editor, 

Program Director, Tobacco Control Research Branch, 

Behavioral Research Program, Division of Cancer Control 

and Population Sciences, National Cancer Institute, 

National Institutes of Health, Bethesda, Maryland.

Ann Malarcher, Ph.D., M.S.P.H., Contributing Editor, 

Consultant, Epidemiologist (Retired), Office on Smoking 

and Health, National Center for Disease Prevention and 

Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Jonathan M. Samet, M.D., M.S., Senior Scientific Editor, 

Dean and Professor, Colorado School of Public Health, 

University of Colorado, Aurora, Colorado.

Gillian L. Schauer, Ph.D., M.P.H., Senior Scientific Editor, 

Senior Consultant (Contractor), Centers for Disease Control 

and Prevention, Atlanta, Georgia; Clinical Instructor, 

Department of Health Services, School of Public Health, 

University of Washington, Seattle, Washington.

Jennifer Unger, Ph.D., Senior Scientific Editor, Professor of 

Preventive Medicine, Keck School of Medicine, University 

of Southern California, Los Angeles, California.

Brian A. King, Ph.D. M.P.H., Senior Associate Editor, 

Deputy Director for Research Translation, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Leslie A. Norman, M.B.A., Managing Editor, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Peter L. Taylor, M.B.A., Technical Editor, Fairfax, Virginia. 

Contributing authors were

Robert T. Adsit, M.Ed., Director of Education and Outreach 

Programs, University of Wisconsin School of Medicine 

and Public Health, Center for Tobacco Research and 

Intervention, Madison, Wisconsin.

Anthony J. Alberg, Ph.D., M.P.H., Professor and Chair, 

Department of Epidemiology and Biostatistics, Arnold 

School of Public Health, University of South Carolina, 

Columbia, South Carolina.

Erik Augustson, Ph.D., M.P.H., Lead, Smokefree.gov 

Initiative, Program Director and Health Scientist, Tobacco 

Control Research Branch, Behavioral Research Program, 

Division of Cancer Control and Population Sciences, 

National Cancer Institute, National Institutes of Health, 

Bethesda, Maryland.

Stephen Babb, M.P.H., Public Health Analyst, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.
A Report of the Surgeon General

x

Timothy B. Baker, Ph.D., Director of Research, Center for 

Tobacco Research and Intervention; Professor, Department 

of Medicine, University of Wisconsin School of Medicine 

and Public Health, Madison, Wisconsin.

William Checkley, M.D., Ph.D., Associate Professor of 

Medicine, Division of Pulmonary and Critical Care, School 

of Medicine, Bloomberg School of Public Health, The 

Johns Hopkins University, Baltimore, Maryland.

Graham A. Colditz, M.D., Dr.P.H., F.A.F.P.H.M., NiessGain Professor of Surgery, Professor of Medicine; Chief, 

Division of Public Health Sciences, Department of 

Surgery; Associate Director, Prevention and Control, Alvin 

J. Siteman Cancer Center; Deputy Director, Institute for 

Public Health, Washington University School of Medicine, 

St. Louis, Missouri.

MeLisa Creamer, Ph.D., M.P.H., Oak Ridge Institute for 

Science and Education Fellow, Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Kirsten S. Dorans, Sc.D., Postdoctoral Fellow, Department 

of Epidemiology, School of Public Health and Tropical 

Medicine, Tulane University, New Orleans, Louisiana. 

Lucinda England, M.D., M.S.P.H., Medical Officer, Division of 

Congenital and Developmental Disorders, National Center 

on Birth Defects and Developmental Disabilities, Centers 

for Disease Control and Prevention, Atlanta, Georgia.

Brenda Eskenazi, Ph.D., Jennifer and Brian Maxwell 

Professor of Maternal and Child Health and Epidemiology, 

Director, Center for Environmental Research and 

Children’s Health, School of Public Health, University of 

California, Berkeley, California.

Michael C. Fiore, M.D., M.P.H., M.B.A., Hilldale Professor 

of Medicine, Director, Center for Tobacco Research and 

Intervention, University of Wisconsin School of Medicine 

and Public Health, Madison, Wisconsin.

Jiang He, M.D., Ph.D., Professor and Joseph S. Copes, 

M.D. Chair; Department of Epidemiology, School of Public 

Health and Tropical Medicine; Director, Tulane University 

Translational Science Institute, Tulane University, New 

Orleans, Louisiana.

Lauren A. Hunter, M.P.H., Graduate Student Researcher, 

Division of Epidemiology, School of Public Health, 

University of California, Berkeley, California.

Eric J. Jacobs, Ph.D., Senior Scientific Director, Behavioral 

and Epidemiology Research Group, American Cancer 

Society, Atlanta, Georgia.

Ahmed Jamal, M.D., M.P.H., Epidemiologist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Glenda Lassi, Ph.D., Genomics Project Leader, Centre for 

Genomics Research, Precision Medicine and Genomics, 

Innovative Medicines and Early Development Biotech 

Unit, AstraZeneca, Cambridge; Research Fellow, Medical 

Research Council Integrative Epidemiology Unit, School 

of Psychological Science, University of Bristol, Bristol, 

United Kingdom.

Adam M. Leventhal, Ph.D., Director, USC Health, Emotion, 

and Addiction Laboratory, Professor, Departments of 

Preventive Medicine and Psychology, University of 

Southern California, Los Angeles, California.

David T. Levy, Ph.D., Professor, Lombardi Comprehensive 

Cancer Center, Georgetown University, Washington, D.C.

Maggie Mahoney, J.D., Public Health Analyst, Carter 

Consulting, Inc. (Contractor), Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Ann Malarcher, Ph.D., M.S.P.H., Contributing Editor, 

Consultant, Epidemiologist (Retired), Office on Smoking 

and Health, National Center for Disease Prevention and 

Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Kristy L. Marynak, M.P.P., Lead Public Health Analyst, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia. 

Tim McAfee, M.D., M.P.H., Senior Medical Officer, Office 

on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Megan B. Miller, Ph.D., Postdoctoral Fellow, Department 

of Psychiatry, Yale University, New Haven, Connecticut.

Marcus R. Munafò, Ph.D., Professor of Biological Psychology, 

School of Psychological Science, University of Bristol, 

Bristol, United Kingdom.
Smoking Cessation

xi

Christina C. Newton, M.S.P.H., Scientist, Behavioral and 

Epidemiology Research Group, American Cancer Society, 

Atlanta, Georgia.

Leslie A. Norman, M.B.A., Public Health Analyst, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Michael K. Ong, M.D., Ph.D., Professor in Residence, 

Division of General Internal Medicine and Health Services 

Research, Department of Medicine, David Geffen School of 

Medicine, Department of Health Policy and Management, 

Jonathan and Karin Fielding School of Public Health, 

University of California; Chief, Hospitalist Division, 

Department of Medicine, Veteran’s Administration Greater 

Los Angeles Healthcare System; Chair, State of California 

Tobacco Education and Research Oversight Committee, 

Los Angeles, California.

Paul R. Pentel, M.D., Professor of Medicine, Division of 

Clinical Pharmacology, University of Minnesota; Chief, 

Pharmacy, Hennepin Healthcare, Minneapolis, Minnesota.

Marina R. Picciotto, Ph.D., Charles B.G. Murphy Professor 

and Deputy Chair for Basic Science in Psychiatry; Professor 

of Neuroscience, of Pharmacology, and in the Child Study 

Center; School of Medicine, Yale University, New Haven, 

Connecticut.

Judith J. Prochaska, Ph.D., M.P.H., Associate Professor of 

Medicine, Stanford Prevention Research Center, Department 

of Medicine, Stanford University, Stanford, California.

Mays Shamout, M.D., M.P.H., Epidemic Intelligence 

Service Officer, Office on Smoking and Health, National 

Center for Chronic Disease Prevention and Health 

Promotion, Centers for Disease Control and Prevention, 

Atlanta, Georgia.

Sundar Shrestha, Ph.D., Senior Economist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Trishul Siddharthan M.D., Postdoctoral Fellow, Division of 

Pulmonary and Critical Care Medicine, The Johns Hopkins 

University, Baltimore, Maryland.

Elliot A. Stein, Ph.D., Chief, Neuroimaging Research 

Branch, National Institute on Drug Abuse, Intramural 

Research Program, National Institutes of Health, Baltimore, 

Maryland.

Carolyn R. T. Stoll, M.P.H., M.S.W., Staff Scientist, Division of 

Public Health Sciences, Department of Surgery, Washington 

University School of Medicine, St. Louis, Missouri.

Dennis R. Trinidad, Ph.D., M.P.H., Associate Professor, 

Department of Family Medicine and Public Health, 

University of California—San Diego, La Jolla, California.

James Tsai, M.D., M.P.H., Epidemiologist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Michael A. Tynan, Public Health Analyst, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Rachel F. Tyndale, Ph.D., Canada Research Chair in 

Pharmacogenomics, Centre for Addiction and Mental 

Health; Professor, Department of Pharmacology and 

Toxicology, Department of Psychiatry, University of 

Toronto, Toronto, Ontario, Canada.

Graham Warren, M.D., Ph.D., Vice Chairman for Research, 

Professor, Department of Radiation Oncology, Department 

of Cell and Molecular Pharmacology and Experimental 

Therapeutics, Medical University of South Carolina, 

Charleston, South Carolina.

Lei Zhang, Ph.D., Health Scientist, Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Reviewers were

Israel Agaku, D.M.D., Ph.D., M.P.H., Senior Scientist, Office 

on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Brian S. Armour, Ph.D., Associate Director for Science, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Stephen Babb, M.P.H., Public Health Analyst, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.
A Report of the Surgeon General

xii

R. Graham Barr, M.D., Dr.P.H., Professor of Medicine 

and Epidemiology, Columbia University Medical Center, 

New York, New York.

Neal L. Benowitz, M.D., Professor of Medicine, 

Bioengineering, and Therapeutic Sciences; Chief, Division 

of Clinical Pharmacology, University of California, San 

Francisco, California.

Carla J. Berg, Ph.D., M.B.A., L.P., Associate Professor, 

Department of Behavioral Sciences and Health Education, 

Rollins School of Public Health; Associate Director for 

Population Sciences, Winship Cancer Institute, Emory 

University Woodruff Health Sciences Center, Atlanta, 

Georgia.

David Berrigan, Ph.D., M.P.H., Program Director, Health 

Behaviors Research Branch, Behavioral Research 

Program, Division of Cancer Control and Population 

Sciences, National Cancer Institute, National Institutes of 

Health, Bethesda, Maryland.

Michele Bloch, M.D., Ph.D., Chief, Tobacco Control 

Research Branch, Behavioral Research Program, Division of 

Cancer Control and Population Sciences, National Cancer 

Institute, National Institutes of Health, Bethesda, Maryland.

Raymond Boyle, Ph.D., M.P.H., Director of Research 

Programs, ClearWay Minnesota, Minneapolis, Minnesota.

Thomas H. Brandon, Ph.D., Chair, Department of Health 

Outcomes and Behavior; Director, Tobacco Research and 

Intervention Program, Moffitt Cancer Center; Professor, 

Departments of Psychology and Oncologic Sciences, 

University of South Florida, Tampa, Florida.

David M. Burns, M.D., Professor Emeritus, Department of 

Family Medicine and Public Health, University of California—

San Diego, School of Medicine, San Diego, California.

Ralph Caraballo, Ph.D., M.P.H., Senior Advisor, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Frank J. Chaloupka, Ph.D., Director, Health Policy 

Center, Research Professor, Division of Health Policy and 

Administration, School of Public Health, University of 

Illinois at Chicago, Chicago, Illinois.

Graham A. Colditz, M.D., Dr.P.H., F.A.F.P.H.M., NiessGain Professor of Surgery, Professor of Medicine; Chief, 

Division of Public Health Sciences, Department of 

Surgery; Associate Director Prevention and Control, Alvin 

J. Siteman Cancer Center; Deputy Director, Institute for 

Public Health, Washington University School of Medicine, 

St. Louis, Missouri.

Jamie R. Cordova, M.P.H., Cancer Research Training Award 

Fellow, Tobacco Control Research Branch, Behavioral 

Research Program, Division of Cancer Control and 

Population Sciences, National Cancer Institute, National 

Institutes of Health, Bethesda, Maryland.

David B. Coultas, M.D., F.A.C.P., Associate Chief of Staff 

Education, Veterans Affairs Portland Health Care System; 

Professor of Medicine, Oregon Health and Science 

University, Portland, Oregon.

Elizabeth Courtney-Long, M.A., M.S.P.H., Deputy Associate 

Director for Science, Office on Smoking and Health, 

National Center for Chronic Disease Prevention and Health 

Promotion, Centers for Disease Control and Prevention, 

Atlanta, Georgia. 

K. Michael Cummings, Ph.D., M.P.H., Professor, Department 

of Psychiatry and Behavior Sciences; Co-Leader, Hollings 

Cancer Center Tobacco Research Program, Medical 

University of South Carolina, Charleston, South Carolina. 

Sue Curry, Ph.D., Interim Executive Vice President and 

Provost, Distinguished Professor of Health Management 

and Policy, University of Iowa, Iowa City, Iowa.

Sean P. David, M.D., S.M., D.Phil., Associate Professor 

of Medicine, Division of Primary Care and Population 

Health, Stanford University School of Medicine, Palo Alto, 

California.

Cristine D. Delnevo, Ph.D., M.P.H., Professor and Director, 

Center for Tobacco Studies, Rutgers School of Public 

Health, New Brunswick, New Jersey.

Dawn L. DeMeo, M.D., M.P.H., Associate Professor of 

Medicine, Harvard Medical School; Associate Physician, 

Channing Division of Network Medicine and the Division 

of Pulmonary and Critical Care, Brigham and Women’s 

Hospital, Boston, Massachusetts.
Smoking Cessation

xiii

Lucinda England, M.D., M.S.P.H., Medical Officer, Division 

of Congenital and Developmental Disorders, National 

Center on Birth Defects and Developmental Disabilities, 

Centers for Disease Control and Prevention, Atlanta, 

Georgia.

Eric J. Feuer, Ph.D., Chief, Statistical Research and 

Applications Branch, Surveillance Research Program, 

Division of Cancer Control and Population Sciences, 

National Cancer Institute, National Institutes of Health, 

Bethesda, Maryland.

Aaron F. Folsom, M.D., M.P.H., Professor, University of 

Minnesota School of Public Health, Division of Epidemiology 

and Community Health, Minneapolis, Minnesota.

Neal D. Freedman, Ph.D., M.P.H., Senior Investigator, 

Metabolic Epidemiology Branch, Division of Cancer 

Epidemiology and Genetics, National Cancer Institute, 

National Institutes of Health, Rockville, Maryland.

Gary A. Giovino, Ph.D., M.S., Professor and Chair, 

Department of Community Health and Health Behavior, 

School of Public Health and Health Professions, University 

at Buffalo, State University of New York (SUNY), Buffalo, 

New York.

Meredith A Grady, M.P.H., Co-Lead, Smokefree.gov 

Initiative, Tobacco Control Research Branch, Behavioral 

Research Program, National Cancer Institute, National 

Institutes of Health, Bethesda, Maryland.

David C. Grossman, M.D., M.P.H., Senior Associate Medical 

Director and Senior Investigator, Kaiser Permanente 

Washington Health Research Institute; Professor, Department 

of Health Service; Adjunct Professor, Department of 

Pediatrics, University of Washington, Seattle, Washington.

Melissa B. Harrell, Ph.D., M.P.H., Associate Professor, The 

University of Texas Health Science Center at Houston, 

School of Public Health, Austin Regional Campus, Austin, 

Texas.

Dorothy K. Hatsukami, Ph.D., Associate Director, Masonic 

Cancer Center; Professor of Psychiatry, University of 

Minnesota, Minneapolis, Minnesota.

Stephen T. Higgins, Ph.D., Director, Vermont Center on 

Behavior and Health, Virginia H. Donaldson Professor 

of Translational Science, Departments of Psychiatry 

and Psychological Science; Vice Chair, Department of 

Psychiatry, University of Vermont, Burlington, Vermont.

Elizabeth S. Holland, M.P.A., Senior Technical Advisor, 

Quality Measurement and Value-Based Incentives Group, 

Division of Health Information Technology, Center for 

Clinical Standards and Quality, Centers for Medicare and 

Medicaid Services, Baltimore, Maryland.

David Homa, Ph.D., M.P.H., Epidemiologist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Corinne G. Husten, M.D., M.P.H., Senior Medical Advisor, 

Office of the Center Director, Center for Tobacco Products, 

U.S. Food and Drug Administration, Silver Spring, 

Maryland.

Maki Inoue-Choi, Ph.D., M.S., Staff Scientist, Metabolic 

Epidemiology Branch, Division of Cancer Epidemiology 

and Genetics, National Cancer Institute, National 

Institutes of Health, Rockville, Maryland.

Prabhat Jha, O.C., M.D., D.Phil., F.C.A.H.S., F.R.S.C., 

Professor, University of Toronto; Chair in Global Health 

and Epidemiology, Dalla Lana School of Public Health; 

Executive Director, Centre for Global Health Research, 

St. Michael’s Hospital, Toronto, Canada.

Michelle C. Kegler, Dr.P.H., M.P.H., Professor, Department of 

Behavioral Sciences and Health Education, Rollins School 

of Public Health, Emory University, Atlanta, Georgia.

Paul J. Kenny, Ph.D., Ward-Coleman Professor and 

Chairman, Department of Neuroscience, Icahn School of 

Medicine at Mount Sinai, New York, New York.

Chris Kotsen, Psy.D., C.T.T.S., N.C.T.T.P., Lead Psychologist, 

Tobacco Quitcenter, Lung Cancer Institute, Steeplechase 

Cancer Center, Robert Wood Johnson Barnabas Health 

University Hospital Somerset, Somerville, New Jersey.

Thomas E. Kottke, M.D., M.S.P.H., Medical Director for WellBeing and Senior Clinical Investigator, HealthPartners 

Institute; Professor, Department of Medicine, University 

of Minnesota, Minneapolis, Minnesota.

Stephanie R. Land, Ph.D., Program Director and 

Statistician, Tobacco Control Research Branch, Behavioral 

Research Program, Division of Cancer Control and 

Population Sciences, National Cancer Institute, National 

Institutes of Health, Bethesda, Maryland.
A Report of the Surgeon General

xiv

Frank T. Leone, M.D., M.S., Director, Comprehensive 

Smoking Treatment Program; Professor, Division of 

Pulmonary, Allergy and Critical Care, University of 

Pennsylvania, Philadelphia, Pennsylvania.

Douglas E. Levy, Ph.D., Associate Professor of Medicine, 

Harvard Medical School, Mongan Institute Health 

Policy Center, Massachusetts General Hospital, Boston, 

Massachusetts.

Shari M. Ling, M.D., Deputy Chief Medical Officer, Centers 

for Medicare and Medicaid Services, Baltimore, Maryland.

Jay H. Lubin, Ph.D., National Institutes of Health Scientist 

Emeritus, Biostatistics Branch, Division of Cancer 

Epidemiology and Genetics, National Cancer Institute, 

National Institutes of Health, Bethesda, Maryland.

F. Joseph McClernon, Ph.D., Director, Center for Addiction 

Science and Technology; Professor, Department of 

Psychiatry and Behavioral Sciences, Duke University 

School of Medicine, Durham, North Carolina.

Paul C. Melstrom, Ph.D., Pharm.D., Senior Research 

Scientist, Office on Smoking and Health, National Center 

for Chronic Disease Prevention and Health Promotion, 

Centers for Disease Control and Prevention, Atlanta, 

Georgia.

Glen D. Morgan, Ph.D., Psychologist, Tobacco Control 

Research Branch, Behavioral Research Program, Division of 

Cancer Control and Population Sciences, National Cancer 

Institute, National Institutes of Health, Bethesda, Maryland.

Ajay K. Nangia, M.B.B.S., F.A.C.S., Professor and Vice Chair 

of Urology, Director of Andrology, Department of Urology, 

University of Kansas Health System, Kansas City, Kansas.

Satomi Odani, M.P.H., Oak Ridge Institute for Science and 

Education Fellow, Office on Smoking and Health, National 

Center for Chronic Disease Prevention and Health 

Promotion, Centers for Disease Control and Prevention, 

Atlanta, Georgia.

S. Michael Owens, Ph.D., Director, Center for Alcohol and 

Drug Abuse Studies; Professor, Department of Pharmacology 

and Toxicology, College of Medicine, University of Arkansas 

for Medical Sciences, Little Rock, Arkansas.

Mark Parascandola, Ph.D., M.P.H., Program Director, 

Tobacco Control Research Branch, Behavioral Research 

Program, Division of Cancer Control and Population 

Sciences, National Cancer Institute, National Institutes of 

Health, Bethesda, Maryland.

Terry F. Pechacek, Ph.D., Professor and Interim Division 

Director of Health Management and Policy, School of 

Public Health, Georgia State University, Atlanta, Georgia.

Megan E. Piper, Ph.D., Associate Professor, Department 

of Medicine, School of Medicine and Public Health, 

University of Wisconsin; Associate Director of Research, 

University of Wisconsin Center for Tobacco Research and 

Intervention, Madison, Wisconsin.

Elizabeth A. Platz, Sc.D., M.P.H., Professor, Department 

of Epidemiology, Bloomberg School of Public Health, The 

Johns Hopkins University, Baltimore, Maryland.

Elizabeth Reimels, J.D., Associate Director for Policy, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Carolyn Reyes-Guzman, Ph.D., M.P.H., Epidemiologist 

and Program Director, Tobacco Research Branch, Control 

Behavioral Research Program, Division of Cancer Control 

and Population Sciences, National Cancer Institute, 

National Institutes of Health, Bethesda, Maryland.

Nancy A. Rigotti, M.D., Professor of Medicine, Harvard Medical 

School; Director, Tobacco Research and Treatment Center, 

Massachusetts General Hospital, Boston, Massachusetts.

Catherine Saucedo, Deputy Director, Smoking Cessation 

Leadership Center, University of California, San Francisco, 

California.

Robert Schnoll, Ph.D., Associate Professor and Program 

Leader, Center for Interdisciplinary Research on Nicotine 

Addiction, Department of Psychiatry; Associate Director 

for Population Science and Co-Leader for Tobacco and 

Environmental Carcinogenesis, Abramson Cancer Center; 

Senior Fellow, Center for Public Health Initiatives, 

University of Pennsylvania, Philadelphia, Pennsylvania.

Steven A. Schroeder, M.D., Professor, Distinguished 

Professorship in Health and Health Care, Department of 

Medicine; Director, Smoking Cessation Leadership Center, 

University of California, San Francisco, California.
Smoking Cessation

xv

Donna R. Shelley, M.D., M.P.H., Professor, Department of 

Population Health; Professor, Department of Medicine, 

New York University School of Medicine; Co-Director, 

Section for Tobacco, Alcohol, and Drug Abuse, New York, 

New York.

Peter G. Shields, M.D., Deputy Director, Comprehensive 

Cancer Center and James Cancer Hospital; Professor, 

College of Medicine, The Ohio State University Wexner 

Medical Center, Columbus, Ohio.

Sundar Shrestha, Ph.D., Senior Economist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Lia J. Sorgen, Cancer Research Training Award Fellow, 

Tobacco Control Research Branch, Behavioral Research 

Program, Division of Cancer Control and Population 

Sciences, National Cancer Institute, National Institutes of 

Health, Bethesda, Maryland.

Frank E. Speizer, M.D., E. H. Kass Distinguished Professor 

of Medicine, Harvard Medical School, Channing Laboratory, 

Department of Medicine, Brigham and Women’s Hospital, 

Boston, Massachusetts.

Margaret R. Spitz, M.D., M.P.H., Professor, Dan L. Duncan 

Comprehensive Cancer Center, Department of Molecular 

and Cellular Biology, Baylor College of Medicine, Houston, 

Texas.

Meir Stampfer, M.D., Dr.P.H., Professor of Epidemiology 

and Nutrition, Harvard T.H. Chan School of Public Health, 

Professor of Medicine, Channing Division of Network 

Medicine, Department of Medicine, Brigham and Women’s 

Hospital and Harvard Medical School, Boston, Massachusetts.

Linda Topping Streitfeld, M.P.H., Social Science Research 

Analyst, Center for Medicare and Medicaid Innovation, 

Centers for Medicare and Medicaid Services, Baltimore, 

Maryland.

Stephanie Sturgis, M.P.H., Program Analyst, Idoneous 

Consulting Services (Contractor), Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Van T. Tong, M.P.H., Epidemiologist, Division of Congenital 

and Developmental Disorders, National Center for Birth 

Defects and Developmental Disability, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Brenna VanFrank, M.D., M.S.P.H., Medical Officer, Office 

on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Robert E. Vollinger, Jr., Dr.P.H., M.S.P.H., Program 

Director, Tobacco Control Research Branch, Behavioral 

Research Program, Division of Cancer Control and 

Population Sciences, National Cancer Institute, National 

Institutes of Health, Bethesda, Maryland.

Kenneth E. Warner, Ph.D., Avedis Donabedian Distinguished 

University Professor Emeritus of Public Health and Dean 

Emeritus, School of Public Health, University of Michigan, 

Ann Arbor, Michigan.

Gordon B. Willis, Ph.D., Tobacco Control Research Branch, 

Behavioral Research Program, Division of Cancer Control 

and Population Sciences, National Cancer Institute, 

National Institutes of Health, Bethesda, Maryland.

Shu-Hong Zhu, Ph.D., Director, Center for Research 

and Intervention in Tobacco Control; Professor, Family 

Medicine and Public Health, University of California 

School of Medicine, San Diego, California.

Other contributors were

Katherine J. Asman, M.S.P.H., Statistician, Biostatistics and 

Epidemiology Division, RTI International, Atlanta, Georgia.

Susan Bratten, Senior Editor, American Institutes for 

Research, Washington, D.C.

Meghan N. Buran, M.P.H., Senior Professional Research 

Assistant to Dr. Jonathan M. Samet, Department of 

Epidemiology, Colorado School of Public Health, University 

of Colorado, Aurora, Colorado.

Deborah A. Burnette, Expert Consultant, ICF International, 

Atlanta, Georgia. 

Amy de Boinville, Production Design Associate, American 

Institutes for Research, Washington, D.C.

Phil Esra, Editor, American Institutes for Research, 

Washington, D.C.

Carolyn Feola Rugamas, Production Design Specialist, 

American Institutes for Research, Washington, D.C.
A Report of the Surgeon General

xvi

Jane Garwood, Senior Editor, American Institutes for 

Research, Washington, D.C.

Andrea S. Gentzke, Ph.D., M.S., Health Scientist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Sondra Hammond, Production Design Associate, American 

Institutes for Research, Washington, D.C.

William A. Harris, M.M., Northrop Grumman (Contractor), 

Division of Adolescent and School Health, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Sean Hu, M.D., M.S., Dr. P.H., Senior Epidemiologist, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Angela Jehle, Director, Publications & Creative Services, 

American Institutes for Research, Washington, D.C.

Devon LaPoint, Project Associate, American Institutes for 

Research, Washington, D.C.

Dara L. Ledford, Senior Manager, Production Design, 

American Institutes for Research, Washington, D.C.

Pamela R. Lemos, M.S., Public Health Analyst, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Yong Liu, M.D., M.S., Statistician, Division of Population 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Christine C. Maisano, Editor, Prana Enterprises, 

Inc. (Contractor), American Institutes for Research, 

Washington, D.C. 

Kathleen Major, K Major Editorial Services (Contractor), 

American Institutes for Research, Washington, D.C.

Kristen N. Mangold, M.S.W., Public Health Advisor, 

National Cancer Institute, National Institutes of Health, 

Rockville, Maryland.

Timothy L. McManus, M.S., Lead Health Scientist, 

Division of Adolescent and School Health, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Richard A. Miech, Ph.D., M.P.H., Principal Investigator, 

Monitoring the Future; Professor, Survey Research 

Center at the Institute for Social Research, University of 

Michigan, Ann Arbor, Michigan.

Matthew Mowczko, M.Des., Graphic Design Specialist, 

American Institutes for Research, Washington, D.C.

Don Mullins, Jr., M.P.H., Project Director, American 

Institutes for Research, Washington, D.C.

Stephanie Neuben, Editor, American Institutes for Research, 

Washington, D.C.

Kim O’Brien, Editor, American Institutes for Research, 

Washington, D.C.

Patrick M. O’Malley, Ph.D., Research Professor, Institute 

for Social Research, University of Michigan, Ann Arbor, 

Michigan.

Andrew Peterman, Lead Production Editor, American 

Institutes for Research, Washington, D.C.

Elyse Phillips, Oak Ridge Institute for Science and Education 

Fellow, Office on Smoking and Health, National Center for 

Chronic Disease Prevention and Health Promotion, Centers 

for Disease Control and Prevention, Atlanta, Georgia.

Ketra L. Rice, Ph.D., M.S., M.B.A., Senior Service Fellow, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Fatma Romeh Ali, Ph.D., Fellow, Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Helen A. Sacco, M.S.Ed., Editor, American Institutes for 

Research, Washington, D.C.

Saida Sharapova, M.D., M.P.H., C.P.H., Epidemiologist, 

Office on Smoking and Health, National Center for Chronic 

Disease Prevention and Health Promotion, Centers for 

Disease Control and Prevention, Atlanta, Georgia.

Kathryn E. Szynal, Editorial Assistant, Idoneous 

Consulting Services (Contractor), Office on Smoking and 

Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.
Smoking Cessation

xvii

Wendy E. Theobald, Ph.D., Researcher, University of 

Wisconsin-Center for Tobacco Research and Intervention, 

University of Wisconsin School of Medicine and Public 

Health, Madison, Wisconsin.

Stacy Thorne, Ph.D., M.P.H., Health Scientist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Sarah Trigger, M.P.H., Social Scientist, Center for Tobacco 

Products, U.S. Food and Drug Administration, Silver 

Spring, Maryland.

Katrina Trivers, Ph.D., M.S.P.H., Epidemiologist, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Sharon Wallace, Production Design Specialist, American 

Institutes for Research, Washington, D.C.

Kimp Walton, M.S., Health Statistician, Office on Smoking 

and Health, National Center for Chronic Disease Prevention 

and Health Promotion, Centers for Disease Control and 

Prevention, Atlanta, Georgia.

Teresa Wang, Ph.D., M.S., Epidemic Intelligence Service 

Officer, Lieutenant, U.S. Public Health Service, Office on 

Smoking and Health, National Center for Chronic Disease 

Prevention and Health Promotion, Centers for Disease 

Control and Prevention, Atlanta, Georgia.

Karen C. Ward, Production Design Specialist, American 

Institutes for Research, Washington, D.C.

Xin Xu, Ph.D., Economist, Center for Tobacco Products, U.S. 

Food and Drug Administration, Silver Spring, Maryland.

Conflict of Interest Disclosures: All senior scientific editors 

and contributing authors have completed and submitted a 

conflict of interest disclosure form. Unless otherwise noted 

below, no potential conflicts of interest were reported. 

Dr. Glenda Lassi reports being employed by AstraZeneca, a 

research-based biopharmaceutical company. Dr. Marcus R. 

Munafò reports receiving grant funding from Pfizer and 

Rusan Pharma and obtaining products for use in research 

from GlaxoSmithKline, a company that manufactures 

smoking cessation products. Dr. Judith J. Prochaska reports 

having served as an ad hoc advisor to Pfizer Inc, a company 

that manufactures smoking cessation medications.

xix

Smoking Cessation

Chapter 1 Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation 1

Introduction 3

Organization of the Report 4

Preparation of the Report 5

Scientific Basis of the Report 5

Major Conclusions 6

Chapter Conclusions 7

The Evolving Landscape of Smoking Cessation 12

References 26

Chapter 2 Patterns of Smoking Cessation Among U.S. Adults, Young Adults, and Youth 35

Introduction 37

Data Sources 37

Key Epidemiologic Measures 42

Trends in Current and Former Cigarette Smoking 43

Changing Characteristics of Current Cigarette Smokers 47

Key Disparities in Current Cigarette Smoking Among Adults and Youth 57

Cigarette Smoking Cessation Among Adults and Youth 59

Other Tobacco Products: Use and Cessation 80

Clinical Interventions for Smoking Cessation: Prevalence and Trends 86

Key Disparities in Cessation Among Adults 100

Summary of the Evidence and Implications 102

Conclusions 104

References 105

Chapter 2 Appendices 111

Appendix 2.1: Sources of Data 113

Appendix 2.2: Measures of Cessation 116

References 121

Chapter 3 New Biological Insights into Smoking Cessation 123

Introduction 125

Cell and Molecular Biology of Nicotine Addiction 125

Vaccines and Other Immunotherapies as Treatments for Nicotine Addiction 137

Insights into Smoking Cessation from the Field of Neurobiology 139

Genetic Studies of Smoking Phenotypes 147

Summary of the Evidence 155

Conclusions 157

References 158

Chapter 4 The Health Benefits of Smoking Cessation 173

Introduction 177

Methodologic Challenges 177

Cancer 177

Smoking Cessation After a Cancer Diagnosis 206
xx

Cardiovascular Disease 214

Smoking Cessation After a Diagnosis of Coronary Heart Disease 270

Chronic Respiratory Disease 305

Reproductive Health 320

References 402

Chapter 5 The Benefits of Smoking Cessation on Overall Morbidity, Mortality, and Economic Costs 437

Introduction 439

Benefits of Smoking Cessation on Overall Morbidity 439

Benefits of Smoking Cessation on All-Cause Mortality 461

Benefits of Smoking Cessation on Economic Costs 465

Summary of the Evidence 485

Conclusions 485

References 486

Chapter 6 Interventions for Smoking Cessation and Treatments for Nicotine Dependence 493

Introduction 495

Literature Review Methods 496

Behavioral and Psychological Treatments 496

Pharmacologic Treatments 509

Teachable Moments 532

Considerations for Subpopulations 537

Emerging Intervention Approaches 544

Summary of the Evidence 546

Conclusions 547

References 549

Chapter 7 Clinical-, System-, and Population-Level Strategies that Promote Smoking Cessation 577

Introduction 579

Literature Review Methods 579

Clinical- and Health System-Based Strategies on Smoking Cessation 581

Population-Based Strategies on Smoking Cessation 598

Modeling to Assess the Impact of Policy and Regulatory Changes on Cessation 613

Limitations and Methodologic Gaps 617

Summary of the Evidence 618

Conclusions 619

References 620

Chapter 8 A Vision for the Future 641

Introduction 643

Past: Historical Perspective 643

Present: Health Benefits of Cessation 649

Future: Ending the Tobacco Use Epidemic 651

References 661

List of Abbreviations 665

List of Tables and Figures 671